Koehler G A, Van Ness C
California Emergency Medical Services Authority, Sacramento 95814, USA.
Prehosp Disaster Med. 1993 Oct-Dec;8(4):359-65. doi: 10.1017/s1049023x0004067x.
On 14 July 1991, at 2150 h, a train derailment occurred near the Cantara rail curve about six miles above Dunsmuir in Northern California. The derailment spilled approximately 19,000 gallons of metam-sodium into the Sacramento River. When mixed with water, metam-sodium degrades to methylisothiocyanate (MITC) and other gases. The contaminated river water passed the town of Dunsmuir and other occupied areas exposing residents to MITC gas. From 15 July to 20 July (five days), a total of 360 people underwent triage. The majority of patients displayed minor exposure symptoms that did not require hospital care. Mercy Mt. Shasta Hospital, a small rural hospital close to Dunsmuir, received the majority of patients. As of 29 July, 15 days after the incident, Mercy Mt. Shasta Hospital had seen 244 exposed patients in its emergency department, and had admitted five. Three had symptoms that could have been spill-related. Three Regional Poison Control Centers provided medical toxicology advice. Medical management of the emergency medical services (EMS) response to the event was piecemeal and weak. There did not appear to be a medical operations component at local Emergency Operations Centers (EOC). Most health care personnel interviewed complained about inadequate information about the substance and the situation. Local fire service mutual-aid agreements to obtain additional fire service and ambulance personnel worked well. It is important to emphasize that everyone who believed they had been exposed to the chemical underwent triage and received appropriate acute medical care.
1991年7月14日21时50分，加利福尼亚州北部邓斯穆尔镇上方约6英里处的坎塔拉铁路弯道附近发生了一起火车脱轨事故。脱轨致使约19000加仑的甲基异硫氰酸钠泄漏到萨克拉门托河中。甲基异硫氰酸钠与水混合后会降解为甲基异硫氰酸酯（MITC）和其他气体。受污染的河水流经邓斯穆尔镇及其他有人居住的地区，使居民暴露于MITC气体中。从7月15日至7月20日（共5天），共有360人接受了伤情分类检查。大多数患者表现出轻微的暴露症状，无需住院治疗。靠近邓斯穆尔镇的一家小型乡村医院——慈悲山沙斯塔医院接收了大部分患者。截至7月29日，即事故发生15天后，慈悲山沙斯塔医院的急诊科共接待了244名暴露患者，其中5人住院。有3人出现的症状可能与泄漏事件有关。3个地区毒物控制中心提供了医学毒理学建议。紧急医疗服务（EMS）对该事件的医疗处理零散且薄弱。当地应急行动中心（EOC）似乎没有医疗行动部门。接受采访的大多数医护人员抱怨称，关于该物质及情况的信息不足。当地消防部门通过互助协议获得了更多消防和救护车人员，运作良好。需要强调的是，所有认为自己接触过该化学品的人都接受了伤情分类检查，并得到了适当的急性医疗护理。
